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TENSION-TYPE HEADACHE

What is a Tension-Type Headache ?

Tension-type headache is the name given to headaches described as pains usually felt all over the head and often extending down to the neck. It is sometimes severe and often constant and worrying, especially in people who have not had headaches before. The headache may be like a tight band around the head, a heavy weight on top of the head, or a pressure feeling as though the brains were trying to burst out of the skull. A slight feeling of nausea may be present and sufferers may dislike bright lights, but often the headache is the only symptom. The headache may occur daily and tends to get worse during the day, but it may also be bad on waking. It can occur in episodes with some headache-free intervals, or it may be present every day for months. This variety of headache is also referred to as muscle contraction headache and tension headache.

How does a Tension-Type Headache occur ?

The cause of the pain is not fully understood. There can be some increased muscle contraction in the neck, face and scalp muscles, but this is not always found. Areas of the scalp may be tender or feel strange. The pain may itself lead to grimacing with added scalp and facial muscle contraction. This may continue even when the patient is asleep. Headache with these features may occur in people taking regular analgesics and may resolve when these drugs are stopped.

Why does a Tension-Type Headache occur ?

Up to 80% of people have some headache of this type at some time in their life. Fortunately, less than 5% have the chronic form of the condition, with unremitting headaches almost every day. There is an association with migraine although the actual headaches and other symptoms are different. Although anxiety, stress and emotional problems are commonly blamed for the headaches, they are not necessarily any more common in headache patients than in people without headache. Lifestyle factors are important however, as headaches of this kind are commonly associated with neck problems such as whiplash injuries, a sedentary lifestyle involving long periods of time sitting in front of a computer screen or occupations requiring intense concentration. Some people with tension-type headaches also suffer from anxiety and depression. Worry that the headache represents something serious often worsens the situation.

Treatment involved for a Tension-Type Headache 

It is important to realise that tension-type headaches do not signify serious disease of the brain. There is often concern that they are caused by a brain tumour and the patient expects to be carefully examined and may request a brain scan, but the chance that a serious brain disorder will be found is extremely small. Tests are not usually necessary. The first step in treatment is to try to identify the cause of the problem. The patient’s lifestyle should be investigated. It may be necessary to ask about occupation, amount and type of exercise taken and any possible stresses at home or at work. The doctor should check on all the treatments that are being taken. If migraine headaches are also occurring, they should be vigorously treated. If there is anxiety it may be helpful to learn how to relax the neck and scalp muscles. For episodic tension-type headache, simple analgesics and physical measures such as massage or the application of cold will often prove effective. Anti-inflammatory drugs such as ibuprofen are also effective. Treatment that can be applied by the patient or by a partner or friend is likely to be more effective than treatment given once a week by appointment. Once the headache becomes chronic, analgesics are usually ineffective and may actually make the situation worse. The recommended treatment is Amitriptyline, not as an antidepressant but in a low dose such as 50 to 100mg daily. It should be used in a low dose initially and only increased when the patient is tolerating the current dose. If there is improvement, the drug should be gradually reduced after 4 to 6 months. A variety of alternative therapies have also been recommended. These include muscle relaxation techniques, acupuncture, and treatments involving manipulation of the neck. Some sort of regular exercise, which does not involve sustained muscular straining, should be encouraged.

During Treatment

Tension-type headaches can be difficult to treat, especially when the headaches themselves cause anxiety. Many of the treatments require patience. A change in the character of the headache, or the development of associated neurological problems may necessitate further investigation or different treatment.

After Treatment

Tension-type headaches tend to recur. Any new symptoms or a change in the features of the headache should be reported to the doctor.

If a Tension-Type Headache is  left untreated

Tension-type headache does not have any serious consequences if it is not treated. However, it can interfere with enjoyment of life, causing difficulties at home and at work.

Effects on family of a Tension-Type Headache 

Tension-type headaches are troublesome and alarming, often making the sufferer irritable. It is important to provide support and understanding. Some family members may get similar headaches or migraines.